{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:05:57Z","timestamp":1779879957289,"version":"3.53.1"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: We aimed to determine whether gynecologic cancer\u2013related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index surgery for gynecologic cancer at a tertiary university hospital. CCD was defined as new clinician-documented cognitive impairment, neurology\/psychiatry consultation, or initiation of cognition-targeted pharmacotherapy \u226530 days postoperatively. Competing events were all-cause death and major neurologic events\/hospice. We fit Fine\u2013Gray subdistribution hazard models adjusted for age, Charlson Comorbidity Index (CCI), cancer stage, and treatment intensity, and evaluated a prespecified age \u00d7 stage interaction. Results: Among 1023 eligible patients (mean age 62.4 \u00b1 11.8 years; 41.3% International Federation of Gynecology and Obstetrics [FIGO] stage III\u2013IV; median CCI 3 [IQR 2\u20135]), CCD occurred in 98 (9.6%). The 12-month cumulative incidence of CCD was 11.2% accounting for competing risks. Advanced stage was independently associated with higher CCD risk (sHR 1.85, 95% CI 1.27\u20132.69; p = 0.001). A significant age \u00d7 stage interaction was observed (p &lt; 0.001), with the strongest association in patients \u226570 years (sHR 2.48, 95% CI 1.61\u20133.81). Perioperative factors associated with CCD included open surgery (sHR 1.54) and postoperative delirium (sHR 2.76); these findings should be interpreted as associative signals rather than validated causal treatment targets. A stratified blinded chart review of 160 patients (80 flagged-positive and 80 unflagged controls) supported the CCD definition (PPV 88.8%; sensitivity 72.1%; specificity 94.3%; NPV 91.5%). Visit-frequency adjustment confirmed robustness (advanced stage sHR 1.78; p = 0.003). Conclusions: Gynecologic cancer\u2013related factors, particularly advanced stage, are independently associated with CCD after accounting for competing risks, and high-risk phenotypes (age \u226570, FIGO III\u2013IV) may benefit from perioperative pathways integrating cognitive screening, delirium prevention, and neurocognitive follow-up.<\/jats:p>","DOI":"10.3390\/medicina62050988","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:19:52Z","timestamp":1779877192000},"page":"988","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Cancer Stage and Comorbidity Burden with 12-Month Clinically Significant Cognitive Decline After Gynecologic Cancer Surgery: A Competing-Risk Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Jaehak","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, Wonkwang University School of Medicine & Hospital, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byoungryun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Wonkwang University School of Medicine & Hospital, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taewan","family":"Won","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wonkwang University School of Medicine & Hospital, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3734-3758","authenticated-orcid":false,"given":"Gyumin","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine & Hospital, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyongseo","family":"Kim","sequence":"additional","affiliation":[{"name":"Wonkwang University School of Medicine, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2472-2908","authenticated-orcid":false,"given":"Cheol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine & Hospital, Iksan 54538, Jeollabuk-do, Republic of Korea"},{"name":"Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 54538, Jeollabuk-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.bja.2017.11.087","article-title":"Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery\u20142018","volume":"121","author":"Evered","year":"2018","journal-title":"Br. 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